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doi: 10.1111/1753-0407.12291
Journal of Diabetes 7 (2015) 591–592
LETTER TO THE EDITOR
Renal function and dapagliflozin in routine clinical practice We read with interest the recent article by Bloomgarden regarding sodium–glucose cotransporter 2 (SGLT-2) inhibitors and renal function.1 The SGLT-2 inhibitors have recently gained popularity due to their beneficial effects on glycemic control, as well as reductions in body weight and blood pressure.2–4 Blood pressure reduction may occur via osmotic diuresis, which could potentially lead to a risk of dehydration and renal impairment. The available literature describes isolated incidents of deterioration in renal function that have resulted in discontinuation of dapagliflozin within Phase 3 clinical trials.2,3 Conversely, there is experimental evidence supporting that SGLT-2 inhibitors are nephroprotective rather than nephrotoxic.1 At present in the UK, dapagliflozin is recommended by the National Institute of Heath and Clinical Excellence (NICE) as monotherapy or in combination with other antidiabetic medications, including insulin in type 2 diabetes.5 We recently conducted a prospective observational assessment to look for changes in renal function associated with dapagliflozin use in our routine secondary care clinical diabetes practice. In line with local practice, dapagliflozin was added to concomitant antidiabetic medications including insulin and glucagon-like peptide-1 (GLP-1) agonist. We performed paired analysis to examine changes in serum creatinine and estimated glomerular filtration rate (eGFR) before and during treatment with dapagliflozin. We identified 49 patients who had been initiated on dapagliflozin and had received a mean (±SD) duration of treatment of 6.5 ± 3.3 months. The mean age of these patients was 55.9 ± 10.5 years and mean duration of diabetes was 8.0 ± 6.3 years. Furthermore, mean body weight was 104.3 ± 17.7 kg, body mass index was 35.9 ± 6.2 kg/m2, baseline HbA1c was 10.3 ± 1.5%, systolic blood pressure (SBP) was 139.4 ± 16.0 mmHg and diastolic blood pressure (DBP) was 79.5 ± 10.3 mmHg. The mean changes in renal function, blood pressure, Correspondence Thinzar Min, Department of Diabetes and Endocrinology, Morriston Hospital, Swansea, SA6 6NL, UK. Tel.: +44 1792 704078 Fax: +44 1792 703214 Email: [email protected] Received 3 March 2015; accepted 16 March 2015.
Table 1 Mean change in renal function, blood pressure, HbA1c and body weight in patients receiving dapagliflozin
Measurement
Baseline
Follow-up
Mean difference (95% CI)
P-value
Creatinine (μmol/L) eGFR (mL/min per 1.73 m2) SBP (mmHg) DBP (mmHg) HbA1c (%) Body weight (kg)
73.4 ± 16.7 81.3 ± 11.2
75.8 ± 21.3 78.6 ± 14.7
2.4 (−1.5, 6.4) −2.8 (−5.6, 0.1)
0.226 0.054
139.4 ± 16.0 79.5 ± 10.3 10.3 ± 1.5 104.3 ± 17.7
137.9 ± 15.4 78.3 ± 9.5 9.1 ± 1.3 101.7 ± 17.2
−1.5 −1.3 −1.2 −2.6
0.407 0.315
doi: 10.1111/1753-0407.12291
Journal of Diabetes 7 (2015) 591–592
LETTER TO THE EDITOR
Renal function and dapagliflozin in routine clinical practice We read with interest the recent article by Bloomgarden regarding sodium–glucose cotransporter 2 (SGLT-2) inhibitors and renal function.1 The SGLT-2 inhibitors have recently gained popularity due to their beneficial effects on glycemic control, as well as reductions in body weight and blood pressure.2–4 Blood pressure reduction may occur via osmotic diuresis, which could potentially lead to a risk of dehydration and renal impairment. The available literature describes isolated incidents of deterioration in renal function that have resulted in discontinuation of dapagliflozin within Phase 3 clinical trials.2,3 Conversely, there is experimental evidence supporting that SGLT-2 inhibitors are nephroprotective rather than nephrotoxic.1 At present in the UK, dapagliflozin is recommended by the National Institute of Heath and Clinical Excellence (NICE) as monotherapy or in combination with other antidiabetic medications, including insulin in type 2 diabetes.5 We recently conducted a prospective observational assessment to look for changes in renal function associated with dapagliflozin use in our routine secondary care clinical diabetes practice. In line with local practice, dapagliflozin was added to concomitant antidiabetic medications including insulin and glucagon-like peptide-1 (GLP-1) agonist. We performed paired analysis to examine changes in serum creatinine and estimated glomerular filtration rate (eGFR) before and during treatment with dapagliflozin. We identified 49 patients who had been initiated on dapagliflozin and had received a mean (±SD) duration of treatment of 6.5 ± 3.3 months. The mean age of these patients was 55.9 ± 10.5 years and mean duration of diabetes was 8.0 ± 6.3 years. Furthermore, mean body weight was 104.3 ± 17.7 kg, body mass index was 35.9 ± 6.2 kg/m2, baseline HbA1c was 10.3 ± 1.5%, systolic blood pressure (SBP) was 139.4 ± 16.0 mmHg and diastolic blood pressure (DBP) was 79.5 ± 10.3 mmHg. The mean changes in renal function, blood pressure, Correspondence Thinzar Min, Department of Diabetes and Endocrinology, Morriston Hospital, Swansea, SA6 6NL, UK. Tel.: +44 1792 704078 Fax: +44 1792 703214 Email: [email protected] Received 3 March 2015; accepted 16 March 2015.
Table 1 Mean change in renal function, blood pressure, HbA1c and body weight in patients receiving dapagliflozin
Measurement
Baseline
Follow-up
Mean difference (95% CI)
P-value
Creatinine (μmol/L) eGFR (mL/min per 1.73 m2) SBP (mmHg) DBP (mmHg) HbA1c (%) Body weight (kg)
73.4 ± 16.7 81.3 ± 11.2
75.8 ± 21.3 78.6 ± 14.7
2.4 (−1.5, 6.4) −2.8 (−5.6, 0.1)
0.226 0.054
139.4 ± 16.0 79.5 ± 10.3 10.3 ± 1.5 104.3 ± 17.7
137.9 ± 15.4 78.3 ± 9.5 9.1 ± 1.3 101.7 ± 17.2
−1.5 −1.3 −1.2 −2.6
0.407 0.315
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